Horizon taps AI provider Solera Health in effort to offer more customized care to members

Horizon Healthcare Services is teaming up with AI company Solera Health to offer customized healthcare to members.

“With Solera’s approach of offering curated condition networks utilizing a value-based care model, Horizon’s intent is to provide a more individualized solution for each member in an efficient and cost-effective way, while continuing to strive to deliver optimal health outcomes,” Horizon official Norville Barrington said in a press release.

Initially, the effort will focus on launching programs for musculoskeletal problems, stress, sleep deprivation, resilience, tobacco cessation and weight management. Providing customized care will result in savings, according to the companies.

Solera's platform steers users toward the preventive services offered by Horizon that best fit their individual needs. Horizon is part of the Blue Cross and Blue Shield Association and is the largest health insurer in New Jersey with about 3.6 million members.

“Solera’s condition management platform reduces the operational burden and complexity of managing point solutions for health plans," the companies said in the release. "Through a single point of integration, Solera provides Horizon with a digital front door to evidence-based non-clinical and clinical solutions.”

Horizon said the partnership will simplify administrative tasks such as claims processing by quickly spotting and fixing any record-keeping errors. It will also report any problems and how they were fixed in order to avoid those issues in the future or at least quickly correct them if they do occur.

“We are delighted to partner with a forward-thinking payer like Horizon to offer personalized health solutions for critical chronic conditions," Mary Langowski, Solera Health’s CEO, said in the press release. "We are excited to offer consumers an elegant way to engage in their health while reducing costs and complexity for Horizon.”

AI's role in healthcare elicits both alarm and excitement in the industry, with many taking a wait-and-see attitude toward the technology.

Randa Deaton, vice president of purchaser engagement at Purchaser Business Group on Health, an organization comprising about 40 large public and private companies, told Fierce Healthcare in an email its member companies “are in constant pursuit of innovative solutions that reduce cost without jeopardizing transparency, care quality or equity, and AI could be one of those avenues; but it is still early, and more work needs to be done to ensure adequate safeguards are in place to provide assurances to large purchasers that individuals don’t slip through the cracks.”

Kevin Kavanagh, M.D., founder and president of the patient advocacy organization Health Watch USA, said he worries about an AI arms race.

“Payers will use AI to evaluate office notes to determine level of payments and to make a coverage eligibility determination for ordered tests and procedures,” Kavanagh told Fierce Healthcare in an email. “On the provider end, Microsoft has announced Dragon Ambient eXperience which will produce a draft clinical note within seconds after a patient visit. The AI system will incorporate insights from unstructured data such as conversations."

"It is not a huge step to envision, the AI written clinical note will be optimized for reimbursement and that the AI will learn from previous claim denial and payments what data to incorporate," he added.